Patient was instructed on how to prevent pressure ulcer. A proper skin care is crucial and involves inspecting skin daily and an individualized bathing schedule, using warm (not hot) water and mild soap. Avoid massage over bony prominences and use lubricants if skin is dry.
Patient was instructed on how to manage pressure that is necessary to avoid future complications. Provide appropriate support surface, repositioning every two hours in bed, off-load heel using pillows or positioning boot, use pillow between legs for side lying.
Patient was instructed on what to avoid in presence of ulcers. Friction and shear need to be reduced. Friction is the mechanical force exerted when skin is dragged against a coarse surface while shear is the mechanical force caused by the interplay of gravity and friction.
Patient was instructed how to reduce friction and shear. Use draw sheet for repositioning, encourage use of trapeze if possible, keep head of bed elevated (if tolerated), elevate foot of bed slightly (if condition permits), use pillow or wedge to support hip (side lying, lateral position), utilize lifts and transfer devices.
Patient was instructed on the optimization of wound environment. Adequate nutrition and hydration, remove nonviable tissue, maintain moisture balance, protect the wound and peri-wound skin, eliminate or minimize pain, cleanse, prevent and manage infection, control odor.
Patient was instructed on adequate nutrition and hydration to minimize wound development. Encourage protein, calorie-dense foods and fluids (unless contraindicated), monitor intake, weight and skin turgor, assess and address impairments in dentition and swallowing.
Patient was instructed on eliminate or minimize pain of wound. Address the cause (remove the source if external, treat the infection or medicate based on physiological stimulus), pharmacological strategies
Patient was instructed on traumatic wounds. Contusions are caused by more extensive tissue trauma after severe blunt or blast trauma. The overlying skin may seem to be intact but later become non-viable. Extensive contusion may lead to infection.
Patient was instructed on wounds contributing facts. In addition to poor circulation, neuropathy, and difficulty moving, factors that contribute to chronic wounds include systemic illness, age and repeated trauma.
Patient was instructed on factors that may contribute to chronic wounds is old age. The skin of older people is more easily damaged, and older cells do not proliferate as fast and may not have an adequate response to stress in terms of gene up regulation of stress related proteins. In older cells, stress response genes are over expressed when the cell is not stressed, but when it is, the expression of these proteins is not regulated by as much as in younger cells.